Linking payment to volume-does it work in oncological surgery in Poland?

Introduction. This study aims to evaluate the impact of a new financing policy (25% bonus) on the centralization of radical surgical procedures for cancer treatment in high-volume hospitals in Poland. It builds on existing research that demonstrates a positive correlation between treatment outcomes and the volume of patients managed at a center, extending to various cancer types and treatment modalities including both surgical and non-surgical approaches. Material and methods. Reimbursement data was collected about all radical surgery procedures related to cancer treatment funded from public sources in Poland in 2019-2022. Hospitals were clustered in three groups: 1) high-volume, 2) “close to” high-volume, and 3) low-volume hospitals. To assess the maximum number of providers in each type of cancer surgery, the volume procedures for low-volume hospitals was recalculated. Results. In the years 2018-2022, over 450 hospitals provided radical surgery services in the 13 cancer groups studied. This value changed slightly during the period under study. In almost half of the analyzed cancer groups, the number of low-volume hospitals is increasing. An increasing number of hospitals are providing services below the thresholds. At the same time, across almost all studied groups, the number of high-volume hospitals also increased. Analysis of the distribution of services by clusters proves the gradual concentration of the market. The share of radical surgery services provided by low-volume hospitals decreased from 39% in 2019 to 35% in 2022. The share of services provided in high-volume hospitals increased gradually from 49% to 57% (highest for prostate, kidney and thyroid cancers). Conclusions. The financial model providing additional revenue for high-volume hospitals with additional requirements regarding the treatment process, as well as having no required minimal volume of procedures, induced the centralization of radical oncology surgery only insignificantly. [ABSTRACT FROM AUTHOR]